Do my Shoes Matter? Footwear vs. Injury Prevention for Runners

Heel cushioned, Arch Support, Minimalist - If you are a runner (or have ever been through a gait/running assessment) I am sure you have heard the previous recommendations and styles of footwear.  But which is best?  Does it matter?  I assure you if you ask Nike, Asics or Reebok the answer is a resounding YES!  But the truth may lie more along the lines of there is no “one size fits all”.  

Running is here to stay, simply turning on your TV and watching the last marathon and seeing over 50,000 runners participating in a sport that can have a 90% injury rate, is evidence enough of this.  Despite the growth in running “technology”, runners continued to be injured at an amazingly high rate.  If you poll runners the most common answers given for why they have running injuries are:  not stretching, excessive training, and/or wearing the wrong shoes.  These are all justifiable however most running assessments will simply just match you to your "deficit" - for instance if your assessment reveals you are a heel striker a recommendation would be to add cushion to your heel, NOT attempt to fix your mechanics in the first place.  If we scour the research, we would all likely agree that there is only one that is truly validated - excessive training.  Despite this, there is continued debate, while marketing strategies and popularity of running shoes continues to increase.  Let’s try to break down some facts.

After the running boom of the 1970s 3 sports podiatrists were gathered by Nike to determine why runner’s were getting injured.  With NO empirical evidence the podiatrists felt that the injuries were related to excessive impact and foot motion (particularly pronation) - enter stability shoes/cushioned heels.  Fast forward to 2009 and “Born to Run”, where Chris McDougall sparked the barefoot debate after he introduced us to the Tarahumara.  The Tarahumara were a group of indians who did not appear to suffer from modern day injuries despite running in sandals for hundreds of miles.  This may be a tough comparison as we would then need to talk about culture, environment, and lifestyle adaptations over the course of hundreds of years.  Most Americans do not exercise at all (at least not to the recommendations of the ACSM), let alone “need” to run/walk for tens of miles a day in sandals when we have cars/trains and desk jobs that have lead to multiple physical adaptations.  While we have been adapting to our desks the Tarahumara have continued to run in a reclusive environment, so we have quite a lot of catching up to do.  (In case you have missed all the information about how detrimental sitting can be, stay tuned, we will be covering that in an upcoming blog.)   As one of our patients noted:

When we were traveling around Asia I noticed a lot of people had really nice, healthy feet. Lot of space between the toes, no crooked toes. Their feet almost looked like hands. They walked barefoot, in flip-flops, or slip-on shoes sort of like Keds.  Contrast that to so many people (here) who have bunions, hammer toes and other serious conditions.”  

Andreo Spina has a lot of great thoughts on this including some fantastic foot drills to work on if you are a runner (or anyone for that matter!).  You can find the video here: 

 

So what to do?  There does not seem to be support for buying shoes based on arch height to prevent injury, furthermore the ACSM recommends against heel cushioned shoes and there is some who suggest minimalist shoes may be associated with more stress fractures (Just ask Vibram how this worked out for them!).  Current research suggests that the mechanics of running in partial minimal shoes are similar to running in traditional shoes, the importance is comfort, feeling and perhaps ensuring additional things such as trunk positioning and running progression are correct.  In our opinion the best way to ensure that you do not suffer from injuries is to establish a proper training protocol.  A PT and/or rehab specialist can help build strength through your hips, foot intrinsics and trunk stabilizers to further the reduction of injury risk.  At the very least whichever shoe you are transitioning in try the guideline below to become accommodated to the footwear before going in and piling up the miles!  So do my shoes matter?  Our answer is not so much…..at least as much as we think.

Here is the link for the latest JOSPT suggestions on how to safely progress your running mileage: http://www.jospt.org/doi/pdf/10.2519/jospt.2014.0506 

What do you feel is the most common reason runner's get injured?  Do you evaluate foot wear including wear patterns, etc as part of your evaluations and treatments?  What has been most helpful?

Until next time Happy Rehabbing!  

References:

Davis, Irene. "The Re-Emergence of the Minimalist Running Shoe." JOSPT44.10 (2014): 775-84.

Ostergaard, Rasmus, et al.. "Excessive Progression in Weekly Running Distance and Risk of Running-Related Injuries: An Association Which Varies According to Type of Injury." JOSPT 44.10 (2014): 739-47.

Tirotti, Bruno, et al. "What Do Recreational Runners Think About Risk Factors for Running Injuries? A Descriptive Study of Their Beliefs and Opinions." JOSPT 44.10 (2014): 733-38.

Warden, Stuart, et al. "Management and Prevention of Bone Stress Injuries in Long Distance Runners." JOSPT 44.10 (2014): 749-65.